Provider Demographics
NPI:1982840930
Name:PATRICELLI, TANIA (LPC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:PATRICELLI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2775
Mailing Address - Country:US
Mailing Address - Phone:203-415-5645
Mailing Address - Fax:
Practice Address - Street 1:173 MONTOWESE ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3887
Practice Address - Country:US
Practice Address - Phone:203-433-0299
Practice Address - Fax:203-643-2042
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid